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Athlete Advisory: Explanation of Key Changes on 2022 WADA Prohibited List

Cover image of the 2022 World Anti-Doping Agency Prohibited List.USADA is a signatory to the World Anti-Doping Code established by the World Anti-Doping Agency (WADA), which means that USADA upholds and enforces WADA rules that govern sport around the world. The WADA Prohibited List is among those rules, as it outlines what substances and methods are prohibited in sport and at what times (at all times, in-competition only, or in certain sports).

WADA conducts an annual review of the List and identifies if substances and methods should be added or removed, as well as if any categories and conditions should be modified or clarified.

WADA recently released the 2022 WADA Prohibited List, which will go into effect on January 1, 2022. The 2022 List includes several changes that athletes should be aware of in case the changes impact their use of substances and treatments.

Glucocorticoids

As of January 1, 2022, ALL glucocorticoid injections are prohibited during the in-competition period. This includes, but is not limited to, injections into joints, bursa, or the epidural space, which are all routes of administration that were previously allowed.

Oral and rectal routes of administration also remain prohibited. For clarification, oral administration of glucocorticoids also includes oromucosal, buccal, gingival and sublingual routes. Dental intracanal application is not prohibited.

WADA has determined that these routes of administration result in a significant level of glucocorticoids circulating in the blood, which has the potential to result in performance enhancement or cause harm to health.

Glucocorticosteroids are permitted both in and out of competition when administered by:

  • inhalation (e.g., glucocorticosteroid inhalers)
  • intranasal (e.g., nasal sprays for allergic rhinitis)
  • ophthalmic (e.g., eye drops)
  • perianal (e.g., topical hemorrhoid creams)
  • dermal (e.g., topical creams to treat rashes or allergic reactions)
  • dental intracanal application

USADA strongly recommends you check your medication and route of administration on Global DRO

Athletes who are required to have a TUE to use corticosteroids in-competition should apply for a TUE if the use of their medication will occur within the time periods established below. To reduce the risk of a positive test, athletes should follow the minimum washout periods recommended by WADA. Click here for more information on glucocorticoids.

Route

Apply for a TUE if you use:

Oral (swallowing, or cream or gel used inside the mouth/on gums/under tongue)

Triamcinolone acetonide within 30 days of a competition*

All other glucocorticoids within 3 days of a competition

Intramuscular injections

Triamcinolone acetonide within 60 days of a competition

Prednisolone & prednisone within10 days of a competition

Betamethasone, dexamethasone & methylprednisolone within 5 days of a competition

Injections into or around joints or tendons, as well as epidural, intrathecal, intrabursal, intralesional (e.g., intrakeloid), intradermal & subcutaneous injections

Triamcinolone acetonide, prednisolone & prednisone within 10 days of a competition

All other glucocorticoids within 3 days of a competition

* Washout period refers to the time from the last administered dose to the time of the start of the in-competition period (i.e., beginning at 11:59 p.m. on the day before a competition in which the athlete is scheduled to participate, unless a different period was approved by WADA for a given sport). This is to allow elimination of the glucocorticoid to below the reporting level.

BPC-157

BPC-157 was not prohibited prior to 2022, but the clinically unapproved experimental peptide was added to the 2022 WADA Prohibited List under the S0 Unapproved Substances category. 

While there appears to be no legal basis for selling BPC-157 as a drug, food, or a dietary supplement, athletes should be aware that BPC-157 is being illegally included in some wellness and anti-aging treatments and products.

Because BPC-157 has not been extensively studied in humans, there is no established safe dose, nor if there is any proven efficacy of this compound to treat specific medical conditions. Since BPC-157 is not an approved therapeutic agent in any country, there is no basis for granting a TUE for this substance.

For more information on BPC-157, click here.

Albuterol (Salbutamol)

Under the 2022 WADA Prohibited List, the daily dosing intervals for albuterol (salbutamol) has been reduced to 600 micrograms (6 puffs) over 8 hours starting from any dose (previously 800 micrograms over 12 hours). The total permitted daily dose remains at 1600 micrograms (16 puffs) over 24 hours.

For example, an athlete could take 600 micrograms (6 puffs) in the first eight hours, 600 micrograms (6 puffs) in the following eight hours, and 400 micrograms (4 puffs) in the remaining eight hours of the day. A Therapeutic Use Exemption (TUE) should be sought for doses that exceed these limits.

For more information on salbutamol and inhaled medications, click here.

More questions?

For questions about specific products, substances, and methods, contact USADA’s Drug Reference Line at drugreference@USADA.org or call (719) 785-2000, option 2.

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